Adult Health Nursing 7th Edition Cooper Test Bank Full Chapter PDF

Adult Health Nursing 7th Edition
Cooper Test Bank

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Chapter 11: Care of the Patient with an Endocrine Disorder
MULTIPLE CHOICE
1. The nurse explains that the negative feedback system controls hormone release by
communication between:
a. the pituitary and the target organ.
b. the thymus and the blood stream.
c. lymphatic system and the target organ.
d. central nervous system and the blood stream.
ANS: A
The amount of hormone released is controlled by a negative feedback system. When the level
of the particular hormone is appropriate, the target organ signals the pituitary to stop the
stimulation of the target organ.
DIF: Cognitive Level: Implementation REF: Page 500 OBJ: 2

TOP: Anatomy KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
2. Which diagnostic test for diabetes mellitus provides a measure of glucose levels for the
previous 8 to 12 weeks?
a. Fasting blood sugar (FBS)
b. Oral glucose tolerance test (OGT)
c. Glycosylated hemoglobin (HbA1c)
d. Postprandial glucose test (PPBG)
ANS: C
Glycosylated hemoglobin (HbA1c)—This blood test measures the amount of glucose that has
become incorporated into the hemoglobin within an erythrocyte. Because glycosylation occurs
constantly during the 120-day life span of the erythrocyte, this test reveals the effectiveness of
diabetes therapy for the preceding 8 to 12 weeks.
DIF: Cognitive Level: Knowledge REF: Page 539, Box 11-2

OBJ: 8 TOP: Glucose monitoring
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
3. Which test will furnish immediate feedback for a newly diagnosed diabetic who is not yet
under control?
a. Fasting blood sugar (FBS)
b. Glycosylated hemoglobin (HgbA1c)
c. Oral glucose tolerance test (OGTT)
d. Clinitest
ANS: A
Diabetics should do a fingerstick blood glucose level test before each meal and at bedtime
each day until their disease is under control. The HgbA1c serum test reveals the effectiveness
of diabetes therapy for the preceding 8 to 12 weeks.
DIF: Cognitive Level: Comprehension REF: Page 539, Box 11-2

OBJ: 9 TOP: Diabetes mellitus
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
4. To which diet should a patient with Cushing syndrome adhere?

a. Less sodium
b. More calories
c. Less potassium
d. More carbohydrates
ANS: A
The diet should be lower in sodium to help decrease edema.
DIF: Cognitive Level: Analysis REF: Page 524, Table 11-3

OBJ: 5 TOP: Cushing syndrome
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
5. The patient is a 20-year-old college student who has type 1 diabetes and normally walks each
evening as part of an exercise regimen. The patient plans to enroll in a swimming class.
Which adjustment should be made based on this information?
a. Time the morning insulin injection so that the peak action will occur during
swimming class.
b. Delete normal walks on swimming class days.
c. Delay the meal before the swimming class until the session is over.
d. Monitor glucose level before, during, and after swimming to determine the need
for alterations in food or insulin.
ANS: D
Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours, as
well as reducing blood pressure and lipid levels. However, exercise can carry some risks for
patients with diabetes, including hypoglycemia.
DIF: Cognitive Level: Analysis REF: Page 530 OBJ: 11

TOP: Diabetes mellitus KEY: Nursing Process Step: Planning
6. What is a long-term complication of diabetes mellitus?

a. Diverticulitis
b. Renal failure
c. Hypothyroidism
d. Hyperglycemia
ANS: B
Long-term complications of diabetes include blindness, cardiovascular problems, and renal
failure.

TOP: Diabetes mellitus KEY: Nursing Process Step: Assessment
7. A patient has returned to his room after a thyroidectomy with signs of thyroid crisis. During
thyroid crisis, exaggerated hyperthyroid manifestations may lead to the development of the
potentially lethal complication of:
a. severe nausea and vomiting.
b. bradycardia.
c. delirium with restlessness.
d. congestive heart failure.
ANS: D
In thyroid crisis, all the signs and symptoms of hyperthyroidism are exaggerated. The patient
may develop congestive heart failure and die.

TOP: Thyroidectomy KEY: Nursing Process Step: Assessment
8. In diabetes insipidus, a deficiency of which hormone causes clinical manifestations?

a. antidiuretic hormone (ADH)
b. follicle-stimulating hormone (FSH)
c. thyroid-stimulating hormone (TSH)
d. adrenocorticotropic hormone (ACTH)
ANS: A
Diabetes insipidus is a transient or permanent metabolic disorder of the posterior pituitary in
which ADH is deficient.
DIF: Cognitive Level: Knowledge REF: Page 507 OBJ: 5

TOP: Diabetes insipidus KEY: Nursing Process Step: Assessment
9. What is an appropriate nursing diagnosis for a patient who has recently been diagnosed with
acromegaly?
a. Ineffective coping
b. Activity intolerance
c. Risk for trauma
d. Chronic low self-esteem
ANS: C
Nursing interventions are mainly supportive. The presence of muscle weakness, joint pain, or
stiffness warrants assessment of the ability to perform activities of daily living (ADLs).

TOP: Acromegaly KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment
10. The purpose of the use of radioactive iodine in the treatment of hyperthyroidism is to:
a. stimulate the thyroid gland.
b. depress the pituitary.
c. destroy some of the thyroid tissue.
d. alter the stimulus from the pituitary.
ANS: C
Radioactive iodine 131 destroys some of the hyperactive thyroid gland to produce a more
normally functioning gland.
DIF: Cognitive Level: Application REF: Page 511, Box 11-1

OBJ: 5 TOP: Radioactive iodine 131
KEY: Nursing Process Step: Implementation
11. Which precaution(s) should the nurse take when caring for a patient who is being treated with
radioactive iodine 131 (RAIU)?
a. Initiate radioactive safety precautions
b. Avoid assigning any young woman to the patient
c. Wait three days after dose before assigning a pregnant nurse to care for this patient
d. Advise visitors to sit at least 10 feet away from the patient
ANS: C
The dose is patient specific and at a very low level. No radioactive safety precautions are
necessary and pregnant nurses can be assigned 3 days after the dose. RAIU is not harmful to
nonpregnant women.
DIF: Cognitive Level: Knowledge REF: Page 511, Box 11-1

OBJ: 5 TOP: Thyroid disorders
12. Why would a patient with hyperthyroidism be prescribed the drug methimazole (Tapa-zole)?
a. To limit the effect of the pituitary on the thyroid
b. To destroy part of the hyperactive thyroid tissue
c. To stimulate the pineal gland
d. To block the production of thyroid hormones
ANS: D
Medical management for hyperthyroidism may include administration of drugs that block the
production of thyroid hormones, such as propylthiouracil or methimazole.
DIF: Cognitive Level: Application REF: Page 511, Table 11-2

OBJ: 5 TOP: Hyperthyroidism
13. What is the postoperative position for a person who has had a thyroidectomy?
a. Prone
b. Semi-Fowler
c. Side-lying
d. Supine
ANS: B
Postoperative management of this patient includes keeping the bed in a semi-Fowler position,
with pillows supporting the head and shoulders. There should be a suction apparatus and
tracheotomy tray available for emergency use.
DIF: Cognitive Level: Application REF: Page 513 OBJ: 7

TOP: Thyroidectomy KEY: Nursing Process Step: Implementation
14. What extra equipment should the nurse provide at the bedside of a new postoperative
thyroidectomy patient?
a. Large bandage scissors
b. Tracheotomy tray
c. Ventilator
d. Water-sealed drainage system
ANS: B
There should be a suction apparatus and tracheotomy tray available for emergency use.

TOP: Thyroidectomy KEY: Nursing Process Step: Planning
15. As the nurse is shaving a patient who is 2 days postoperative from a thyroidectomy, the
patient has a spasm of the facial muscles. What should the nurse recognize this as?
a. Chvostek sign
b. Montgomery sign
c. Trousseau sign
d. Homans sign
ANS: A
The spasm of facial muscles when stimulated is the Chvostek sign, an indication of
hypocalcemic tetany.

TOP: Chvostek sign KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity
16. The human insulin whose onset of action occurs within ____ minutes is lispro (Humalog).
a. 30
b. 60
c. 15
d. 45
ANS: C
Humalog begins to take effect in less than half the time of regular, fast-acting insulin. The
new formula can be injected 15 minutes before a meal.
DIF: Cognitive Level: Knowledge REF: Page 533, Table 11-5

OBJ: 13 TOP: Insulin KEY: Nursing Process Step: Planning
17. What should the nurse caution a type I diabetic about excessive exercise?
a. It can increase the need for insulin and may result in hyperglycemia.
b. It can decrease the need for insulin and may result in hypoglycemia.
c. It can increase muscle bulk and may result in malabsorption of insulin.
d. It can decrease metabolic demand and may result in metabolic acidosis.
ANS: B
The patient with diabetes should exercise regularly. Exercise can reduce insulin resistance and
increase glucose uptake for as long as 72 hours, as well as reducing blood pressure and lipid
levels. However, exercise can carry some risks for patients with diabetes, including
hypoglycemia.
TOP: Diabetes mellitus KEY: Nursing Process Step: Implementation
18. What do the Chvostek sign and the Trousseau sign indicate?
a. Low levels of serum calcium
b. High levels of blood sugar
c. Low levels of serum sodium
d. High levels of serum aldosterone
ANS: A
Low levels of blood calcium may cause the Chvostek sign and Trousseau sign.

TOP: Chvostek sign KEY: Nursing Process Step: Assessment
19. A patient has undergone tests that indicate a deficiency of the parathyroid hormone secretion.
She should be informed of which potential complication?
a. Osteoporosis
b. Lethargy
c. Laryngeal spasms
d. Kidney stones
ANS: C
Decreased parathyroid hormone levels in the blood stream cause a decreased calcium level.
Severe hypocalcemia may result in laryngeal spasm, stridor, cyanosis, and increased
possibility of asphyxia.
DIF: Cognitive Level: Comprehension REF: Page 520 OBJ: 5

TOP: Hypoparathyroidism KEY: Nursing Process Step: Implementation
20. The nurse caring for a 75-year-old man who has developed diabetes insipidus following a
head injury will include in the plan of care provisions for:
a. limiting fluids to 1500 mL a day.
b. encouraging physical exercise.
c. protecting patient from injury.
d. discouraging daytime naps.
ANS: C
The patients need protection from injury because they are often exhausted from sleep
deprivation and having to get up frequently at night. Fluids should not be limited and their
energy should be preserved.

TOP: Diabetes insipidus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
21. The physician orders an 1800-calorie diabetic diet and 40 units of (Humulin N) insulin U-100
subcutaneously daily for a patient with diabetes mellitus. Why would a mid-afternoon snack
of milk and crackers be given?
a. To improve nutrition
b. To improve carbohydrate metabolism
c. To prevent an insulin reaction
d. To prevent diabetic coma
ANS: C
Humulin N insulin starts to peak in 4 hours. The nurse should be alert for signs of
hypoglycemia (a less-than-normal amount of glucose in the blood, usually caused by
administration of too much insulin, excessive secretion of insulin by the islet cells of the
pancreas, or dietary deficiency) at the peak of action of whatever type of insulin the patient is
taking.

OBJ: 13 TOP: Diabetes mellitus
22. The nurse teaching a patient with type 1 diabetes mellitus (IDDM) about early signs of
insulin reaction would include information about:
a. abdominal pain and nausea.
b. dyspnea and pallor.
c. flushing of the skin and headache.
d. hunger and a trembling sensation.
ANS: D
The patient should be instructed to notify a member of the nursing staff if any signs of
hypoglycemic (low insulin) reaction occur: excessive perspiration or trembling.

OBJ: 9 TOP: Insulin reaction
23. The nurse discovers the type 1 diabetic (IDDM) patient drowsy and tremulous, the skin is cool
and moist, and the respirations are 32 and shallow. These are signs of:
a. hypoglycemic reaction; give 6 oz of orange juice.
b. hyperglycemic reaction; give ordered regular insulin.
c. hyperglycemic hyperosmolar nonketotic reaction; squeeze glucagon gel in buccal
cavity.
d. hypoglycemic reaction; give ordered insulin.
ANS: A
Hypoglycemic reaction is due to not enough food for the insulin. Quick acting
carbohydrates—such as orange juice or longer acting foods such as milk, crackers, and
cheese—are beneficial.
DIF: Cognitive Level: Comprehension REF: Page 540, Table 11-6

OBJ: 9 TOP: Diabetes mellitus complications
24. A patient has come to the clinic because of enlarged hands and feet, amenorrhea, and
increased hair growth. These symptoms most likely indicate problems with the:
a. pituitary gland.
b. adrenal glands.
c. thyroid gland.
d. pancreas.
ANS: A
The pituitary gland may produce an overabundance of growth hormone. This overproduction
of hormones may cause changes throughout the patient’s body, including enlargement of the
pituitary gland and hands and feet. Female patients may develop a deepened voice, increased
facial hair growth, and amenorrhea.

TOP: Acromegaly KEY: Nursing Process Step: Assessment
25. What instructions should a nurse give to a diabetic patient to prevent injury to the feet?
a. Soak feet in warm water every day.
b. Avoid going barefoot and always wear shoes with soles.
c. Use of commercial keratolytic agents to remove corns and calluses are preferred to
cutting off corns and calluses.
d. Use a heating pad to warm feet when they feel cool to the touch.
ANS: B
Sturdy, properly fitting shoes should be worn. Use of corn removers and heating pads is not
beneficial to preserve the health of a diabetic’s feet.

TOP: Foot care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
26. The physician prescribes glyburide (Micronase, DiaBeta, Glynase) for a patient, age 57, when
diet and exercise have not been able to control type 2 diabetes. What should the nurse include
in the teaching plan about this medication?
a. It is a substitute for insulin and acts by directly stimulating glucose uptake into the
cell.
b. It does not cause the hypoglycemic reactions that may occur with insulin use.
c. It is thought to stimulate insulin production and increase sensitivity to insulin at
receptor sites.
d. It lowers blood sugar by inhibiting glucagon release from the liver, preventing
gluconeogenesis.
ANS: C
Oral hypoglycemics are compounds that stimulate the beta cells in the pancreas to increase
insulin release.

OBJ: 8 TOP: Medications KEY: Nursing Process Step: Planning
27. A 27-year-old patient with hypothyroidism is referred to the dietitian for dietary consultation.
What should nutritional interventions include?
a. Frequent small meals high in carbohydrates
b. Calorie-restricted meals
c. Caffeine-rich beverages
d. Fluid restrictions
ANS: B
A high-protein, high-fiber, lower calorie diet is given.

TOP: Hypothyroidism KEY: Nursing Process Step: Planning
28. What instructions should be included in the discharge instructions for a 47-year-old patient
with hypothyroidism?
a. Taking medication whenever symptoms cause discomfort
b. Decreasing fluid and fiber intake
c. Consuming foods rich in iron
d. Seeing the physician regularly for follow-up care
ANS: D
Regular checkups are essential, because drug dosage may have to be adjusted from time to
time.

TOP: Hypothyroidism KEY: Nursing Process Step: Planning
29. How should the nurse administer insulin to prevent lipohypertrophy?

a. At room temperature
b. At body temperature
c. Straight from the refrigerator
d. After rolling bottle between hands to warm
ANS: A
In fact, it is now believed that insulin should be administered at room temperature, not straight
from the refrigerator, to help prevent insulin lipohypertrophy.

TOP: Diabetes mellitus KEY: Nursing Process Step: Implementation
30. A patient with a history of Graves disease is admitted to the unit with shortness of breath. The
nurse notes the patient’s vital signs: T 103° F, P 160, R 24, BP 160/80. The nurse also notes
distended neck veins. What does the patient most likely have?
a. Pulmonary embolism
b. Hypertensive crisis
c. Thyroid storm
d. Cushing crisis
ANS: C
In a thyroid crisis, all the signs and symptoms of hyperthyroidism are exaggerated.
Additionally, the patient may develop nausea, vomiting, severe tachycardia, severe
hypertension, and occasionally hyperthermia up to 41° C (106° F). Extreme restlessness,
cardiac arrhythmia, and delirium may also occur. The patient may develop heart failure and
may die.

TOP: Hyperthyroidism KEY: Nursing Process Step: Assessment
31. What is the master gland of the endocrine system?

a. Thyroid
b. Parathyroid
c. Pancreas
d. Pituitary
ANS: D
The pituitary gland, located in the brain, is the master gland of the endocrine system. It has
been called the “master gland” because through the negative feedback system, it exerts its
control over the other endocrine glands.

TOP: Pituitary gland KEY: Nursing Process Step: Assessment
32. What information should be obtained from the patient before an iodine-131 test?
a. Presence of metal in the body
b. Allergy to sulfa drugs
c. Status of possible pregnancy
d. Use of prescription drugs for hypertension
ANS: C
Iodine-131 is not a radiation hazard to the nonpregnant patient but is absolutely
contraindicated during pregnancy. Pregnant nurses should not care for this patient for several
days.

TOP: Iodine-131 KEY: Nursing Process Step: Assessment
33. The patient being treated for hypothyroidism should be instructed to eat well-balanced meals
including intake of iodine. Which of the following foods contains iodine?
a. Eggs
b. Pork
c. White bread
d. Skinless chicken
ANS: A
The hypothyroid diet should be adequate in intake of iodine, in foods such as saltwater fish,
milk, and eggs; fluids should be increased to help prevent constipation.

TOP: Hypothyroidism KEY: Nursing Process Step: Assessment
34. The nurse is caring for a patient who is receiving calcium gluconate for treatment of
hypoparathyroid tetany. Which assessment would indicate an adverse reaction to the drug?
a. Increase in heart rate
b. Flushing of face and neck
c. Drop in blood pressure
d. Urticaria
ANS: C
Indications of an adverse effect of calcium gluconate are dyspnea, bradycardia, and
hypotension.

TOP: Calcium gluconate for tetany KEY: Nursing Process Step: Assessment
35. The nurse cautions the patient who is being instructed on self-medication with insulin to be
aware that there are 25-, 30-, 50-, and 100-unit syringes. How is the 100-unit syringe marked?
a. 1-unit increments
b. 2-unitt increments
c. 4-unit increments
d. 5-unit increments
ANS: B
The 100-unit syringe is marked in 2-unit increments while the smaller syringes are marked in
1-unit increments.

TOP: Insulin administration KEY: Nursing Process Step: Implementation
MULTIPLE RESPONSE
36. Which of the following are signs and symptoms of hypoglycemia? (Select all that apply.)
a. Irritability
b. Dry mouth
c. Tremors
d. Diaphoresis
e. Fruity breath
f. Deep respirations
ANS: A, C, D
Hypoglycemic reaction: rapid shallow respirations, irritability, tremors, excessive
perspiration, and possibly loss of consciousness.

OBJ: 9 TOP: Hypoglycemia
37. What are the three major life-threatening complications postoperatively of a thyroidectomy?
(Select all that apply.)
a. Hemorrhaging
b. Seizures
c. Tetany
d. Hypoglycemia
e. Thyroid crisis (storm)
f. SIADH
ANS: A, C, E
The nurse must be alert for signs of internal or external bleeding. In addition to hemorrhage,
two significant postoperative complications exist after thyroidectomy. The first is tetany. The
second is thyroid crisis. Manipulation of the thyroid during surgery may cause the release of
large amounts of thyroid hormones into the blood stream, creating a thyroid crisis (storm).

TOP: Thyroidectomy KEY: Nursing Process Step: Assessment
38. The adrenal cortex secretes glucocorticoids. The most important is cortisol. What is it
involved in? (Select all that apply.)
a. Glucose metabolism
b. Releasing androgens and estrogens
c. Providing extra reserve energy during stress
d. Decreasing the level of potassium in the blood stream
e. Increasing retention of sodium in the blood stream
ANS: A, C
Cortisol is involved in glucose metabolism and provides extra reserve energy in times of
stress.

TOP: Adrenal cortex KEY: Nursing Process Step: Assessment
39. What should the nurse include in provisions for the postoperative care of the patient who had
a thyroidectomy? (Select all that apply.)
a. Assessing ability to speak by asking him or her to recite name and address every
hour
b. Maintaining anatomic position of the head when moving a patient
c. Assisting a patient to hyperextend the head to assess for muscle damage
d. Doing voice check every 2 hours
e. Turning, coughing every hour
f. Checking for bleeding at the sides and the back of the head
ANS: B, D, F
The nurse should hold the head in an anatomic position when moving the patient to prevent
tension on the suture line, do a voice check every 2 to 4 hours by asking the patient to say
“ah”; the patient is not turned nor is coughing recommended immediately after a
thyroidectomy.

TOP: Postoperative thyroidectomy KEY: Nursing Process Step: Planning
40. The nurse would instruct a patient with hyperthyroidism (Graves disease) to select which of
the following nutritious foods because of the increased metabolism related to the disease.
(Select all that apply.)
a. Coffee with cream
b. Lean meat
c. White bread
d. Leafy green vegetables
e. Supplemental vitamin D
ANS: B, D, E
Nutritious food sources, such as food high in protein (e.g., lean meat), sources of vitamin B
(e.g., leafy green vegetables), and vitamin D supplements are helpful to meet the metabolic
needs of the patient with hyperthyroidism.

TOP: Diet for hyperthyroidism KEY: Nursing Process Step: Implementation
41. The nurse would instruct a patient who is hypocalcemic from hypoparathyroidism about a diet
that should include (select all that apply):
a. High phosphorus foods
b. Canned fish with the bones
c. Cucumbers
d. Tofu
e. Bananas
f. Vitamin D supplements
ANS: B, C, D, F
The hypocalcemic patient should eat a high-calcium, low-phosphorus diet that includes
canned fish, cucumbers, tofu, and vitamin D supplements as an aid to the absorption of the
calcium.

TOP: Diet for hypocalcaemia KEY: Nursing Process Step: Implementation
COMPLETION
42. The nurse is administering long-acting insulin once a day, which provides insulin coverage for
24 hours. This insulin is _________________.
ANS:
Lantus
Lantus is a long-acting synthetic (recombinant DNA origin, human-made) human insulin. It is

used once a day at bedtime and works around the clock for 24 hours.
DIF: Cognitive Level: Implementation REF: Page 532, Table 11-5

OBJ: 3 TOP: Insulin KEY: Nursing Process Step: Planning
43. Another term for hyperglycemic reaction is ____________ ______________.
ANS:
diabetic ketoacidosis (DKA)
diabetic ketoacidosis
DKA
Hyperglycemic reaction—the body eliminates the excess glucose by the kidneys releasing it
in the urine. Diabetic ketoacidosis (DKA) (acidosis accompanied by an accumulation of
ketones in the blood), formerly called diabetic coma, may develop and the patient could die.
DKA is a severe metabolic disturbance caused by an acute insulin deficiency, decreased
peripheral glucose use, and increased fat mobilization and ketogenesis.

OBJ: 10 TOP: Hyperglycemia
44. Only ________insulin can be administered intravenously.
ANS:
regular
Insulin is given subcutaneously, although intravenous (IV) administration of regular insulin

can be done when immediate onset of action is desired.

OBJ: 13 TOP: Insulin KEY: Nursing Process Step: Assessment
45. A condition with a deficiency in growth hormone is called ________________.
ANS:
hypopituitary dwarfism
A condition with a deficiency in growth hormone is called hypopituitary dwarfism. Most

cases are idiopathic, but a small number can be attributed to an autosomal-recessive trait. In
some cases there is also a lack of adrenocorticotropic hormone (ACTH), TSH, and the
gonadotropins.

TOP: Dwarfism KEY: Nursing Process Step: Assessment
46. ________________is the term that describes a condition of normal thyroid function.
ANS:
Euthyroid
Euthyroid is the term that describes a condition of normal thyroid function.

TOP: Euthyroid KEY: Nursing Process Step: N/A
47. When the nurse inflates the sphygmomanometer cuff exceeding the systolic blood pressure
and observes a carpal spasm, this is a(n) __________ ____________.
ANS:
Trousseau sign
Trousseau sign is a carpal spasm brought on by pressure of a cuff. This is an indicator for
hypocalcemia and hypomagnesemia.

TOP: Trousseau sign KEY: Nursing Process Step: Assessment
OTHER
48. Arrange the steps of the negative feedback system in the control of blood glucose in
chronologic order. (Separate letters by a comma and space as follows: A, B, C, D):
a. Elevation of blood glucose

b. Decrease in blood glucose
c. Beta cells repressed
d. Beta cells of pancreas stimulated to excrete insulin
e. Intake of nutrients
ANS:
E, A, D, B, C
After the intake of food the blood glucose increases, which stimulates the beta cells of the
pancreas to excrete insulin. Insulin decreases the blood glucose and the negative feedback
system represses the beta cells of the pancreas.

TOP: Negative feedback system KEY: Nursing Process Step: N/A
49. Arrange the steps of drawing up a short-acting and a long-acting insulin in the same syringe.
(Separate letters by a comma and space as follows: A, B, C, D)
a. Draw up amount of shorter-acting insulin

b. Check insulin dose with a second licensed nurse
c. Inject the desired amount of air into the long-acting insulin
d. Clean rubber stopper of both vials with alcohol
e. Draw up desired amount of longer-acting insulin
f. Inject the desired amount of air into the short-acting insulin
ANS:
D, C, F, A, E, B
When drawing up two different types of insulin, the two vials are prepared by cleansing the
tops, air is injected in the longer-acting insulin, air is injected into the short-acting insulin,
and the required dose is drawn up. Set the vial of short-acting insulin out of reach to prevent
accidental reuse. Handing the plunger securely, insert the needle in the long-acting insulin and
withdraw the dose very carefully. Check the dose with a licensed nurse before administering.
DIF: Cognitive Level: Analysis REF: Page 534, Box 11-3

OBJ: 14 TOP: Mixing insulin
Another random document with
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sustained a very great loss by a violent and sudden flood, which
carried away the said mill, with a considerable quantity of paper,
materials and tools, with other things therein, whereby they were
reduced to great distress; and, therefore, recommending to such
persons as should be disposed to lend them aid, to give the sufferers
“relief and encouragement, in their needful and commendable
employment,” as they were “desirous to set up the paper-mill
again.”—This certificate is without date: but Mr. Penn was twice in
Pennsylvania. He first arrived in the year 1682, and returned to
England in 1684; his second arrival was in 1699, and he finally left
the province in 1701. It was probably during the latter period of his
residence in his proprietary-dominion, though, perhaps, in the first,
that the Germantown paper-mills were destroyed.
The William Rittinghousen (so Mr. Penn writes the name) here
mentioned, is supposed to be the same named in the text, and to
have been the great-grandfather of our astronomer. In Mr. Penn’s
certificate he is called an old man, and is stated to have then been
“decrepid.”
In order to shew the present importance of that article, as a

manufacture, in the United States, and which was first fabricated in
this country by the Rittenhouses, the reader is presented with the
following view of the quantity of paper, of various descriptions,
annually made at one hundred and eighty-five paper-mills, within the
United States; taken from the latest information furnished on this
subject.
Tons. Reams. Value.

For Newspapers, 500 50,000 $150,000
[59a]
Books, 630 70,000 245,000

Writing, 650 111,000 333,000
Wrapping, 800 100,000 83,000
—-— —-—- —-—-—
—
2580 331,000 811,000
59a. The number of Newspapers, printed annually in the United States, is
estimated at twenty-two and an half millions.
60. Mr. Benjamin Rittenhouse, a younger brother of David,

speaking of his paternal ancestors, in a letter addressed to the writer
of these memoirs, says: “The family originally settled in the state of
New-York, while a Dutch colony; and were, undoubtedly, the first
paper-makers in America.” This fact was also communicated to the
writer, by Dr. Franklin, some years before.
61. At the peace of Breda, in 1667, the Dutch colony of New

Netherlands was confirmed to the English, to whom it had been
ceded in 1664. But the Dutch having reduced the country in the
years 1672 and 1673, it was finally restored to the English by the
peace of Westminster, on the 9th of February, 1674. The
Rittenhouses are supposed to have seated themselves, before this
latter period, in that part of the colony afterwards called East-Jersey.
Some of the name reside in the state of New-Jersey, at this day; but
it is not known that any of them are inhabitants of the state of New-
York. Those in New-Jersey, with most of those of the name in
Pennsylvania, are descendants of Nicholas.
62. The Rittenhouses who first settled in America, are supposed to

have leaned towards the religious tenets of (if they did not belong to)
that peaceable branch of the Anabaptists, denominated Mennonites.
Simon Menno, the founder of this sect, was one of the first
reformers: he was born at a village called Witmarsum, in the
Batavian province of Friesland, in 1505; the same year in which John
Knox was born, and four years before the birth of Calvin.
Menno had been a priest of the Roman Catholic Church, and

some have endeavoured to stigmatize him, as one who was “a
notorious profligate.” This, however, may be attributed to his having
left the communion of the church of which he was originally a
member: for, he is represented to have been “a man of probity, of a
meek and tractable spirit, gentle in his manners, pliable and
obsequious in his commerce with persons of all ranks and
characters, and extremely zealous in promoting practical religion and
virtue, which he recommended by his example as well as by his
precepts.” He was, moreover, a man of genius and eloquence, and
possessed a considerable share of learning. This extraordinary man
died in the duchy of Holstein, in the year 1561.
The fundamental principles of the followers of Menno are, in some

respects, similar to those of the people called Quakers: They use,
likewise, great plainness in their apparel, and adhere to some of the
practices of the primitive Christian church. But this peaceable sect
baptize adults, and celebrate the eucharist in a manner peculiar to
themselves.
Some of Menno’s disciples came into Pennsylvania from New-

York, in the year 1692. The principal congregation of this sect was
established at Germantown, soon after the Rittenhouses had settled
themselves there; and this may be considered as the mother of the
sect, in America. The Mennonites have since become a numerous
body in Pennsylvania, principally in the county of Lancaster; and this
religious society comprehends, among its members, many intelligent
worthy men, and valuable citizens.
63. In the Preface to a printed copy of the celebrated Speech

delivered in the House of Assembly of Pennsylvania, on the 24th of
May, 1764, by the late John Dickinson, Esq. the Merits of the
Founder of Pennsylvania, as they were declared at various times, in
the proceedings of the Legislative Body of the colony, and in some
other public Documents, are thus summed up by the writer.
“WILLIAM PENN,
A Man of Principles truly humane;
An Advocate for
Religion and Liberty;
Possessing a noble Spirit,
That exerted itself
For the Good of Mankind;
was
The great and worthy Founder
of
Pennsylvania.
To its Inhabitants, by Charter,
He granted and confirmed
Many singular Privileges and Immunities,
Civil and Religious,
Which he continually studied
To preserve and defend for them;
Nobly declaring,
That they had not followed him so far,
To lose a single tittle
Of the Great Charter,
To which all Englishmen were born.
For these Services,
Great have been the Acknowledgements
Deservedly paid to his Merit;
And his Memory
Is dear to his People,
Who have repeatedly confessed,
That,
Next to Divine Providence,
Their Happiness, Prosperity, and Increase
Are owing
To his wise Conduct and singular Goodness;
Which deserve ever to be remembered
With
Gratitude and Affection,
By
Pennsylvanians.”
For the materials of which the foregoing Eulogy is composed, its

author[63a] has referred his readers to the Minutes of Assembly, for
the years 1719 and 1725, to those from the year 1730 to 1740, both
inclusive, excepting only 1736, 1737 and 1739; also, for 1745, 1755
and 1756; to other proceedings of the assembly, in the years 1730
and 1738; and to their Address to Governor John Penn, in 1764.
A very respectable Memorial of another nature, in honour of the
justly celebrated Penn, decorates the edifice of a noble public
institution in the capital of his former domain; an institution devoted
to the purposes of charity, humanity and benevolence. It is a finely
executed metallic statue, in bronze, of that great man; representing
him in his appropriate attire, and holding in his right hand The
Charter of Privileges.[63b] The statue stands on an elegant pedestal of
marble, in an handsome area on the south front of the Pennsylvania
Hospital: and the four sides of the pedestal contain these modest
inscriptions; viz.
“William Penn—Born, 1644—Died, 1718.”

(And underneath, the Family-Arms, with his Motto; viz.)
“Mercy—Justice.”
“Pennsylvania Granted by Charles II. to William Penn,

1681.”
“The Proprietary arrived in 1682; made a just and amicable

arrangement with the Natives, for the purchase of their Lands; and
went back to England in 1684.”
“Returned to Pennsylvania, 1699; and finally withdrew to his

Paternal Estate, 1701.”
The public in general, with the Pennsylvania Hospital more

particularly, are indebted for this Memorial of true Greatness, to the
munificence of a Grandson of the Founder of the extensive Dominion
that bears his name; John Penn, of Stoke-Poges in
Buckinghamshire, Esquire; by whom the statue was presented, in
the year 1804.
63a. In the continuation of the Life of Dr. Franklin, (written by the late Dr.
Stuber, of Philadelphia,) it is said that the Preface to Mr. Dickinson’s Speech was
drawn up by the late learned Provost Smith, and that Dr. Franklin wrote the
Preface to Mr. Galloway’s, in reply.
63b. See Note 64
64. The Charter of Privileges, granted and solemnly confirmed to

the freemen of Pennsylvania and territories belonging to the
province, by the proprietary, on the 28th of October, 1701, was, after
being approved and agreed to by the legislative body of the
province, accepted by them the same day; in lieu of the Frame of
Government originally stipulated between Mr. Penn and the Planters,
in the year 1683. The first article of this charter provided for a full
enjoyment of the Liberty of Conscience, by all persons who should
acknowledge “One Almighty God, the Creator, Upholder, and Ruler
of the World.” It also declared to be capable of holding any office or
place, under the government, all persons professing faith in “Jesus
Christ, the Saviour of the World,” and who should, when required,
attest their allegiance, &c.
65. Incorporated with that edition of the Laws of Pennsylvania,

which was published in the year 1810, “under the authority of the
legislature,” with Notes and References, by Charles Smith, Esq. is
an article that bears a respectful testimony to the justice and
clemency of the founder of that state: It is an important and very
interesting Note to an act of assembly passed the 1st day of April,
1784, (entitled, “An act for opening the Land-Office, for granting and
disposing of the unappropriated Lands within this State,”) containing
“a connected view of the land-titles of Pennsylvania from its first
settlement to the present time.” In this document the learned editor
speaks of the integrity and virtuous policy manifested by Penn, with
respect to his conduct towards the Indian natives of the country, to
which he had acquired the dominion under his sovereign, in these
terms.
“William Penn, although clothed with powers as full and

comprehensive as those possesed by the adventurers from Portugal
and Spain, was influenced by a purer morality and sounder policy.
His religious principles did not permit him to wrest the soil, by force,
from the people to whom God and nature gave it, nor to establish his
title in blood; but, under the shade of the lofty trees of the forest, his
right was fixed by treaties with the natives, and sanctified, as it were,
by incense smoking from the calumet of peace.”
The note from which this extract is made, (and which comprizes
156 large 8vo. pages, printed on a small type,) forms a valuable
treatise, historical as well as legal, of the territorial rights of the
former proprietaries, and of the land-titles deduced from them by the
citizens of Pennsylvania.
66. Germantown was settled in the year 1682. It was so called by

its founders, a small colony of Germans from the Palatinate, mostly
from the vicinity of the city of Worms, who are said to have been
converted while in their own country, to the principles of the people
called Quakers, by the preaching of William Ames, an Englishman.
Germantown is now a populous village, of considerable extent; and
by reason of its proximity to the capital, this place furnishes an
agreeable residence to many respectable families from thence. See
also Note 62.
67. This township derives its name (which it gave also to Mr.
Rittenhouse’s patrimonial farm and his original observatory,) as does
likewise the neighbouring town of Norriston, the county-town of the
(now) county of Montgomery, from the respectable Pennsylvania
family of Norris; of which Isaac Norris, Esq. was eighteen times
chosen Speaker of the General Assembly of Pennsylvania, during
the term of half a century from the time of his first election, in the
year 1713. Mr. Norris held many public offices in Pennsylvania with
great reputation and honour. He is represented as having been “an
ornament to his country;” and this gentleman, who died in the year
1735, then held the Chief-Justiceship of the Province.
68. In the year 1683, Enoch Flower undertook to teach English in

the town of Philadelphia. Six years afterwards, originated the
Friends’ Public School in the same town, then in its infancy; and in
1697, this school was incorporated, on the petition of Samuel
Carpenter, Edward Shippen, Anthony Morris, James Fox, David
Lloyd, William Southby, and John Jones, in behalf of themselves and
others. In the year 1708, this corporation was enlarged and
perpetuated by a new charter, under the name of “The Overseers of
the Public School, founded in Philadelphia, at the request, cost, and
charges of the people called Quakers.” It was further extended in the
year 1711; when the three first named gentlemen, together with
Griffith Owen, Thomas Story, Richard Hill, Isaac Norris, Samuel
Preston, Jonathan Dickinson, Nathan Stanbury, Thomas Masters,
Nicholas Waln, Caleb Pusey, Rowland Ellis and James Logan, were
appointed Overseers.
As this was the earliest considerable school established in

Pennsylvania, as well as the first institution of the kind, in the
province, the names of its promoters deserve to be held in
remembrance, among the Patrons of learning and useful knowledge
in this country.
From this view of the origin of schools in the capital of

Pennsylvania, it will be perceived, that the means of acquiring even
the rudiments of literary instruction must have been difficult of
access in country places, for some considerable time after the
periods just mentioned. This is one of the most serious grievances to
which the settlers in new and unimproved countries are subjected.
69. Margaret, who intermarried with Edward Morgan; Esther, with

the Rev. Thomas Barton; David, the subject of these Memoirs;
Andrew, who died in his minority; Anne, who intermarried with
George Shoemaker; Eleanor, who intermarried with Daniel Evans;
Benjamin, yet living; Jonathan, who died in his minority; and Mary
and Elizabeth (twins,) of whom the latter died in her minority,
unmarried: Mary, who is living, has been twice married, but without
issue; her first husband was Thomas Morgan. David had no sons;
and two of his three brothers having died young and unmarried, the
only persons, descended from our philosopher’s father, Matthias,
who now bear the name of Rittenhouse, are the surviving brother of
David, namely, Benjamin, and his sons. Benjamin has been twice
married; first, to a daughter of General John Bull; and, secondly, to a
daughter of Colonel Francis Wade: By both marriages he has male
issue; and, as it is believed, two of the sons by the first wife are
married.
70. “There is,” says a late ingenious writer,[70a] “a strong propensity

in the human mind to trace up our ancestry to as high and as remote
a source as possible.” “This principle of our nature,” he observes,
“although liable to great perversion; and frequently the source of
well-founded ridicule, may, if rightly directed, become the parent of
great actions. The origin and progress of individuals, of families, and
of nations, constitute Biography and History, two of the most
interesting departments of human knowledge.”
The pride of ancestry is, indeed, “liable to great perversion,” and is

too frequently “the source of well-founded ridicule:” yet the
experience and the history of mankind, in every age and country,
have shewn, that it is connected with and derived from principles of
our nature, which are not only laudable in themselves, but such as, if
“rightly directed” and properly applied, become eminently useful to
society.
70a. See a “Discourse delivered before the New-York Historical Society, at
their anniversary meeting, December the 6th, 1811: By the Hon. De Witt Clinton,
one of the Vice-Presidents of the Society.”
71. It is not this occupation that, in itself, usually attaches to those

who follow it, the idea of clownishness: but it is the ignorance that,
unfortunately, too generally characterizes persons employed in it,
which, by an association of ideas, is apt to derogate from the
worthiness of the employment itself. If the profession of husbandry
be an honourable one, and every rational consideration renders it
such, then one of the most important operations in conducting the
great business of the agriculturist, cannot be destitute of dignity. To
follow the plough is not a servile labour: it is an employment worthy
of a freeman; and if the person, thus engaged, be a man of native
talents, aided by some improvement of mind, scarcely any
occupation can afford him greater scope for philosophic reflection.
While, therefore, the reader contemplates the celebrated

Rittenhouse, such as he was in his maturer years; and then takes a
retrospective view of the embryo-philosopher in the period of his
youth, directing the plough on his father’s freehold; let it be
recollected, that the sovereigns of a mighty empire, in the Eastern
world, occasionally guide this truly important machine with their own
hands, in honour of agriculture: let him recal to his mind, that, in the
proudest days of the Roman republic, consuls, dictators, senators,
and generals, were not unfrequently called forth from the actual
occupancy of this implement of husbandry, by the voice of their
country; and, seizing either the civil or the military helm of its
government, with hands indurated by the toils of the peaceful field,
have by the wisdom of their counsel, or by their valour, supported the
tottering fabric of the state and saved the commonwealth: let them
remember, in fine, that—
“In ancient times, the sacred plough employ’d

The kings and awful fathers of mankind;”[71a]
and that Washington, himself, the pride and boast of his age as
well as country, disdained not to engage himself, personally, in
agricultural pursuits.
71a. Thomson’s Spring.
72. This gentleman was commissioned by Governor Mifflin, in the

year 1791, to be one of the associate judges of the court of common
pleas, in and for the county of Montgomery: but his tenure of this
office was afterwards vacated, by his removal to Philadelphia.
73. “Astronomy,” says Mr. B. Rittenhouse, in the letter before
referred to, “appeared at a very early day to be his favourite study;
but he also applied himself industriously to the study of opticks, the
mechanical powers,” &c.
74. The zeal and attention with which our young philosopher
pursued his early studies, and such mechanical objects as are more
intimately connected with those branches of natural philosophy to
which he was most devoted, will appear from the following extract of
a letter, addressed by him to Mr. Barton, on the 20th of September,
1756, being then little more than twenty-four years of age; viz. “I
have not health for a soldier,” (the country was then engaged in war,)
“and as I have no expectation of serving my country in that way, I am
spending my time in the old trifling manner, and am so taken with
optics, that I do not know whether, if the enemy should invade this
part of the country, as Archimedes was slain while making
geometrical figures on the sand, so I should die making a telescope.”
75. It is observable, that, in like manner, an accidental

circumstance seems to have given the first impulse to the
philosophical researches of that eminent mathematician, Colin
Maclaurin, the friend and disciple of Newton. His biographer, Mr.
Murdoch, relates, that “his genius for mathematical learning
discovered itself so early as at twelve years of age; when, having
accidentally met with a copy of Euclid in a friend’s chamber, in a few
days he became master of the first six books, without any
assistance: and thence, following his natural bent, made such a
surprising progress, that very soon after we find him engaged in the
most curious and difficult problems.”
It is not ascertained at what age Rittenhouse obtained access to

his uncle Williams’s little collection of books and papers; though it
was, probably, before his twelfth year. But it is to be observed, that at
the early age of twelve, Maclaurin had been a year at the University
of Glasgow, where he was placed under the care of one of the most
eminent and learned professors of the age; while Rittenhouse, for
some years after that period of life, had his time occupied in
agricultural pursuits, and was almost entirely uneducated.
One particular in which similar merit attaches itself to these two

distinguished philosophers, is, that all their more serious studies
were directed towards objects of general utility.
Having introduced the name of Maclaurin more than once into

these Memoirs, the author of them cannot refrain from presenting to
his readers the following epitaph upon that great mathematician. It is
attributed to the late Dr. Johnson: the delicacy and chasteness of the
sentiment, as well as the classical purity of the language, certainly
render it a specimen of this species of composition worthy of the pen
of that justly-admired writer.—
H. L. P. E.
Non ut nomine paterno consulat;
Nam tali auxilio nil eget;
Sed, ut in hoc infelici campo,
Ubi luctus regnant et pavor,
Mortalibus prorsus non absit solatium:
Hujus enim scripta evolve,
Mentemque tantarum rerum capacem,
Corpori caduco superstitem crede.
The writer of the Adversaria, in a respectable periodical

publication,[75a] observes, that “it would not be easy to do justice to
this elegant and nervous sentence, in English.” But, as he has given
a very good prose translation of it into our language, the subjoined
versification of this was attempted by a young lady, at the request of
the writer of these memoirs:—
Not to perpetuate his father’s praise,

For no such aid his lofty fame requir’d,
Did filial piety the marble raise;
But other thoughts the friendly deed inspir’d.
Here, in this tearful vale, where sorrow dwells
And trembling mortals own the reign of fear,
At his command, the sculptur’d tablet tells,
Where hope exists, to dry the wand’rer’s tear.
For, read his works, O man! and then believe,
The mind that grasp’d at systems so sublime,
Beyond the mortal part must ever live,
And bloom, in sacred heav’n’s ethereal clime.
75a. The Port-Folio.
76. In order to gratify the curiosity, if not to remove the doubts, of

such persons as are not disposed to believe in the reality of any
thing like an hereditary power, bias, or propensity of the mind, the
following memorable instances are selected from many others which
might be adduced; to shew that mental faculties, as well as corporeal
qualities and even mental and bodily diseases, are sometimes
inherited by children from their parents: perhaps cases of this kind
exist more frequently than is either observed or imagined.
Mr. James Gregory, the inventor of the reflecting telescope in

common use, called the Gregorian, was one of the most
distinguished mathematicians of the seventeenth century. This
eminent man, who was born at Aberdeen in Scotland in the year
1638, was a son of the Rev. Mr. John Gregory, minister of Drumoak
in the same county: his mother was, moreover, a daughter of Mr.
David Anderson, of Finzaugh, a gentleman who possessed a
singular turn for mathematical pursuits.
Mr. David Gregory, a nephew of the foregoing, was some time

Savilian professor of astronomy at Oxford. This Subtilissimi Ingenii
Mathematicus, as he is styled by his successor Dr. Smith, was born
at Aberdeen, in the year 1661. Of the four sons of this celebrated
mathematician,—
David, a mathematician, was regius professor of modern history,
at Oxford;
James was professor of mathematics, at Edinburgh; and
Charles was also professor of mathematics, at St. Andrew’s.
Besides these men of genius in the same family, was the late Dr.
John Gregory, professor of medicine in the University of Edinburgh;
who had previously held the philosophical chair in the University of
St. Andrews, from which he delivered lectures on the mathematics,
experimental philosophy, and moral philosophy. This gentleman was
grandson of the inventor of the Gregorian telescope, son of Dr.
James Gregory, professor of medicine at Aberdeen, and father of
another James, successor of Dr. Cullen, in the medical chair at
Edinburgh.
A mathematical genius was hereditary in the family of the

Andersons; and, from them, it seems to have been transmitted to
their descendants of the name of Gregory. Alexander Anderson,
cousin-german of David abovementioned, was professor of
mathematics at Paris, in the beginning of the eighteenth century; and
published there in 1712, Supplementum Apollonii redivivi, &c. The
mother of the James Gregory, first named, inherited the genius of
her family; and observing in her son, while yet a child, a strong
propensity to mathematics, she herself instructed him in the
elements of that science.
Margaret, the mother of the late Dr. Thomas Reid, professor of

moral philosophy in the University of Glasgow, was a daughter of
David Gregory, Esq. of Kinnardie in Banffshire, elder brother of the
James Gregory first mentioned. It is remarked by a celebrated writer,
that “the hereditary worth and genius which have so long
distinguished, and which still distinguish, the descendants of this
memorable family, are well known to all who have turned their
attention to Scottish biography: but it is not known so generally, that
in the female line, the same characteristical endowments have been
conspicuous in various instances; and that to the other monuments
which illustrate the race of the Gregories, is to be added the
philosophy of Reid.”—(See Dugald Stewart’s Account of the Life and
Writings of Dr. Reid.)
The great mathematical genius of the celebrated astronomer, John

Dominick Cassini, descended to his great-grandson. John-James,
the son of John-Dominick, who inherited the genius of his father,
succeeded him as professor of astronomy in the Royal Observatory
at Paris, a place which the father had filled more than forty years:
John-James’s son, Cæsar-Francis Cassini de Thury, (who died in the
year 1784, at the age of seventy years,) was an eminent astronomer:
and his son, the Count John-Dominick de Thury, was also a
distinguished astronomer.
The eldest of these Cassini’s was a native of Italy, and born in

1625. He died in the seventy-seventh year of his age; and in the year
1695, a medal was struck to honour his memory, by order of the king
of France.
These instances of genius in three families, afford striking

examples of its being sometimes hereditary. It is further observable,
that, in the case of the great professor Simson, his mathematical
endowments were said to be derived from his mother’s family; as Mr.
Rittenhouse’s were likewise supposed to have been from that of his
mother.
77. Mr. Barton resided on a farm, near what are called the Sulphur
Springs (now comprehended within the limits of the new county of
Adams,) from some time in the year 1755, until the spring of 1759;
during which period he officiated as a missionary from “the society,”
established in England, “for the propagation of the gospel in foreign
parts,” for the counties of York and Cumberland. While he resided in
that then remote settlement of Pennsylvania, he was greatly
instrumental, both by his precept and example, in stimulating the
people to avenge the numerous barbarities perpetrated on the
inhabitants and their property in that frontier, by their French and
Indian enemies. In the expedition against Fort Du Quesne (now
Pittsburg,) undertaken in the year 1758, under the orders of
brigadier-general Forbes, he served as a chaplain to the forces then
employed, by virtue of a commission from governor Denny: and in
that campaign he became personally acquainted not only with the
commander in chief, but, among others, with colonel (afterwards
general) Washington; colonel (afterwards general) Mercer; colonel
Byrd of Virginia; colonel Dagworthy; colonel James Burd of
Pennsylvania; all provincial officers of great merit; besides colonel
(afterwards general) Bouquet, sir John St. Clair, sir Peter Hacket,
major Stewart, and other gentlemen of worth and distinction, who
held commands in the British regiments engaged in that service.
With most of these very respectable military characters Mr. Barton
occasionally corresponded, afterward; and his services, during a
residence of between three and four years in that part of
Pennsylvania, were honourably acknowledged, as well in England as
among his fellow-citizens, in various instances.
After Mr. Barton left the county of York, he became established in

Lancaster, where he officiated as rector of St. James’s church in that
borough, and missionary to the large and respectable country-
congregations of Caernarvon and Pequea, nearly twenty years.
78. Although commonly called Dunker’s-Town, the proper name of

this once noted village is Ephrata. The little community which
formerly resided there, usually styled Dunkers, date the origin of their
sect about the year 1705. The original members of this religious
society, in Germany, Switzerland, and some other parts of Europe,
having been persecuted and banished from their homes, assembled
themselves in the duchy of Cleves, under the protection of the king
of Prussia: and from thence they migrated to Pennsylvania, mostly
between the years 1718 and 1734, a few of them only remaining
behind. See also the next note.
79. The proper name of this place is Ephrata; and the very
singular religious society to whom it belongs, are denominated
Seventh-Day Baptists.
The society is said to have originally consisted of about twenty

families who migrated from Germany to Pennsylvania, about the
year 1718 or 1719; part of whom settled at this place, and founded
the village of Ephrata (the head-quarters of the sect,) which is
situated about thirteen miles, north-eastward, from Lancaster, on a
little stream called the Cocolico-creek. These people hold the
doctrine of an universal redemption, ultimately, denying the eternity
of future punishment; that war and judicial oaths are unchristian; and
that it is not justifiable to take interest, for money lent. They keep the
seventh day of the week as their sabbath, and baptize by
submersion; whence they derive their name: they also inculcate the
propriety of celibacy, and of maintaining a community of goods; but
when any of them marry, and acquire property independent of the
society in Ephrata, they are obliged to retire from thence and reside
elsewhere. The men generally wear their beards, and clothe
themselves in a habit not unlike that of the Carmelites or White
Friars: the women dress like nuns. Both men and women observe
great abstemiousness in their diet, living chiefly on vegetables, and
submit to some privations and corporal severities, besides, in their
religious discipline; they lie upon benches, with a wooden block
instead of a pillow: but though meek, humble, and even timid, in their
deportment, they are very civil to strangers who visit them.
The society of Ephrata is supported by cultivating their lands,

conducting a printing-press, a grist-mill, a paper-mill, a saw-mill, a
tan-yard, &c. and the women are employed in spinning, knitting,
sewing, making paper-lanterns and other toys, &c.
The village consists of about ten or a dozen buildings; and is

mostly composed of the cloisters and convent, two churches, and
the mills. One of their places of worship adjoins the sisters’
apartments, as a chapel; another belongs to the brothers’
apartments: and to these churches, the brethren and the sisterhood
respectively resort, every morning and evening, sometimes, too, in
the night, for the purpose of worshipping; much of which is made up
of soft and melodious chanting, by the females. There is said to be
one other place of worship, wherein all the members of the society,
within the bounds of the settlement, meet once a week to celebrate
worship publicly.
Such, indeed, was the pleasant, sequestered little village of
Ephrata, at the time our then very young philosopher visited it; and
such was the condition of that little-known sect of Christians, while
the society continued under the direction of their second and last
president, the late Mr. Peter Miller. This venerable old German, who
had been bred to the priesthood in some one of the Protestant
churches of his native country, became a convert to the principles of
this obscure ascetic sect, over which he long presided with much
reputation, after the death of its reputed founder, Conrad Beixler,
his patriarchal predecessor. But, though possessing a good share of
the old scholastic learning, with a large portion of piety, the mind of
Mr. Miller was strongly tinctured with many mystical notions in
divinity; such as well comported with the “whimsies” of the religious
society he governed.
Since the death of this good man, the ancient discipline of the
religious community at Ephrata, which had become greatly relaxed
during the revolutionary war, has almost wholly disappeared. The
chief seat of the Seventh-Day Baptists is no longer what it was: for,
in lieu of the solemn devotional stillness of the secluded cloysters
and cells of its once monastic inhabitants, and which, at this time,
are nearly deserted, are now substituted various occupations of
industry, amidst “the busy haunts of men.”
A letter from lady Juliana Penn to the second and last worthy
president of this little religious society, has a place in the Appendix. It
is indicative of the goodness of her ladyship’s heart.
80. The county-town of Berks, in Pennsylvania, pleasantly situated

on the Schuylkill, about fifty-six miles, north-westward, from
Philadelphia.
81. A neighbouring township to Norriton, the place of Mr.

Rittenhouse’s country residence.
82. This farm contained about one hundred and fifty acres. It was
lately sold by the heirs of Dr. Rittenhouse.
83. “Omnium autem rerum, ex quibus aliquid acquiritur, nihil est
agriculturâ melius, nihil uberius, nihil dulcius, nihil homine, nihil libero
dignius,” Cic. De Offic. ii. 42.
84. The opinion, that Mr. Rittenhouse was, in his youth and the
first years of his manhood, “without literary friends or society, and
with but two or three books,” though erroneous in fact, was
propagated pretty early; and that opinion has, since, generally
prevailed. About twenty-two years before his death, a book was
published in Philadelphia, under the title of Caspipina’s Letters; of
which the Rev. Mr. Duché, then assistant-minister of Christ-church
and St. Peter’s in that city, was the writer. In that pleasant little work,
its amiable and worthy author (who has been dead many years) has
thus mentioned our philosopher. “After taking a few turns in the
garden, we walked back again to the college, where we had
appointed to meet the modest and ingenious Mr. Rittenhouse, who,
without one single advantage from a private tutor, or public
education, by the mere force of genius and industry, may now justly
be reckoned the first astronomer and mathematician in the world.”
Under such circumstances as these, it is by no means a matter of

surprise, that Dr. Rush should have been led into a similar mistake.
It is, nevertheless, truly astonishing to find an American writer (the

late Rev. Mr. Linn,) who, five years after Dr. Rittenhouse’s death,
published in Philadelphia, where both resided, a poem entitled, “The
Powers of Genius;” but, in which the name of Rittenhouse is not
once noticed! And yet that gentleman had not omitted to introduce, in
one of his notes, an observation which shews, that an European
philosopher, also of sublime genius, was present to his mind’s eye!
—“From the exhibitions of American talents,” said Mr. Linn, “I indulge
the warmest expectations. I behold, in imagination, the Newtons,
the Miltons, and the Robertsons, of this new world; and I behold the
sun of genius” (likewise “in imagination,” it is presumed,) “pouring on
our land his meridian beams.”
The writer of these memoirs believes Dr. Linn to have been a very
worthy, as well as an ingenious man: as such, he regrets his
premature death, and entertains a respect for his memory. But he
could not, in justice to the merit of Dr. Rittenhouse’s character, pass
unnoticed so unaccountable an omission as the one just mentioned,
in Dr. Linn’s Poem.
85. Dr. Herschel, by means of his admirable telescopes, the most

powerful that have ever been constructed, discovered on the 13th of
March, 1781, a new planet without the orbit of Saturn, called the
Georgium Sidus. The newly discovered star was thus named by Dr.
Herschel himself, in honour of his patron King George III. by whose
bounty he was enabled to construct, and to make incessant and
laborious observations with those wonderful telescopes, by which
this astronomer has extended our knowledge of the planetary and
sidereal system, far beyond its former limits.[85a]
Some astronomers on the continent of Europe, and in America

likewise, have affected to call this new planet Herschel; while others
have endeavoured to give it the name of Uranus. Would it not be
well, in order to avoid the perplexity and confusion arising from
various names for the same thing, that astronomers of eminence
should designate this planet, in future, by the name which the
discoverer—who, it may be presumed, was best entitled to give it a
denomination—chose to apply to it? It is a strange kind of
compliment to Dr. Herschel, if it could have been intended as a mark
of respect to him, to refuse an adoption of that name which he had
assigned to his own discovery; even by changing it for that of the
Doctor himself! He wished this planet, no doubt, to retain the
appellation of Georgium Sidus, as a memorial of his grateful respect
for his royal benefactor; and in this object of his wish he would be
disappointed, by changing it for any other.
The name Uranus is also objectionable, and on another ground.

Uranus was a fabulous personage. It is pretended, that in the isle
called Panchay,[85b] to the east of Africa, is to be seen on a column of
gold, a recital of the principal actions of Uranus, together with those
of Saturn and Jupiter. It is said that the former was the most ancient
king in the world; and that, having been a just and beneficent man,

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DIF: Cognitive Level: Implementation REF: Page 500 OBJ: 2

DIF: Cognitive Level: Knowledge REF: Page 539, Box 11-2

DIF: Cognitive Level: Comprehension REF: Page 539, Box 11-2

4. To which diet should a patient with Cushing syndrome adhere?

DIF: Cognitive Level: Analysis REF: Page 524, Table 11-3

DIF: Cognitive Level: Analysis REF: Page 530 OBJ: 11

6. What is a long-term complication of diabetes mellitus?

DIF: Cognitive Level: Analysis REF: Page 538 OBJ: 15

DIF: Cognitive Level: Analysis REF: Page 513 OBJ: 7

8. In diabetes insipidus, a deficiency of which hormone causes clinical manifestations?

DIF: Cognitive Level: Knowledge REF: Page 507 OBJ: 5

DIF: Cognitive Level: Analysis REF: Page 503 OBJ: 5

DIF: Cognitive Level: Application REF: Page 511, Box 11-1

DIF: Cognitive Level: Knowledge REF: Page 511, Box 11-1

DIF: Cognitive Level: Application REF: Page 511, Table 11-2

DIF: Cognitive Level: Application REF: Page 513 OBJ: 7

DIF: Cognitive Level: Analysis REF: Page 513 OBJ: 7

DIF: Cognitive Level: Analysis REF: Page 513 OBJ: 5

DIF: Cognitive Level: Knowledge REF: Page 533, Table 11-5

DIF: Cognitive Level: Knowledge REF: Page 513 OBJ: 6

DIF: Cognitive Level: Comprehension REF: Page 520 OBJ: 5

DIF: Cognitive Level: Application REF: Page 508 OBJ: 5

DIF: Cognitive Level: Analysis REF: Page 532, Table 11-5

DIF: Cognitive Level: Application REF: Page 540, Table 11-6

DIF: Cognitive Level: Comprehension REF: Page 540, Table 11-6

DIF: Cognitive Level: Analysis REF: Page 503 OBJ: 5

DIF: Cognitive Level: Analysis REF: Page 537 OBJ: 8

DIF: Cognitive Level: Analysis REF: Page 544, Table 11-7

DIF: Cognitive Level: Analysis REF: Page 515 OBJ: 5

DIF: Cognitive Level: Application REF: Page 515 OBJ: 5

29. How should the nurse administer insulin to prevent lipohypertrophy?

DIF: Cognitive Level: Application REF: Page 534 OBJ: 8

DIF: Cognitive Level: Analysis REF: Page 513 OBJ: 8

31. What is the master gland of the endocrine system?

DIF: Cognitive Level: Knowledge REF: Page 500 OBJ: 1

DIF: Cognitive Level: Knowledge REF: Page 511 OBJ: 5

DIF: Cognitive Level: Application REF: Page 515 OBJ: 8

DIF: Cognitive Level: Application REF: Page 520 OBJ: 5

DIF: Cognitive Level: Knowledge REF: Page 534 OBJ: 14

DIF: Cognitive Level: Application REF: Page 540, Table 11-6

DIF: Cognitive Level: Comprehension REF: Page 513 OBJ: 7

DIF: Cognitive Level: Comprehension REF: Page 502 OBJ: 3

DIF: Cognitive Level: Application REF: Page 513 OBJ: 7

DIF: Cognitive Level: Application REF: Page 512 OBJ: 5

DIF: Cognitive Level: Application REF: Page 512 OBJ: 5

Lantus is a long-acting synthetic (recombinant DNA origin, human-made) human insulin. It is

DIF: Cognitive Level: Implementation REF: Page 532, Table 11-5

43. Another term for hyperglycemic reaction is ____________ ______________.

DIF: Cognitive Level: Knowledge REF: Page 540, Table 11-6

44. Only ________insulin can be administered intravenously.

Insulin is given subcutaneously, although intravenous (IV) administration of regular insulin

DIF: Cognitive Level: Knowledge REF: Page 533, Table 11-5

45. A condition with a deficiency in growth hormone is called ________________.

A condition with a deficiency in growth hormone is called hypopituitary dwarfism. Most

DIF: Cognitive Level: Knowledge REF: Page 506 OBJ: 5

DIF: Cognitive Level: Knowledge REF: Page 512 OBJ: 5

DIF: Cognitive Level: Application REF: Page 513 OBJ: 6

a. Elevation of blood glucose

DIF: Cognitive Level: Analysis REF: Page 503 OBJ: 2

a. Draw up amount of shorter-acting insulin

DIF: Cognitive Level: Analysis REF: Page 534, Box 11-3

43. Another term for hyperglycemic reaction is __.